1265733703 NPI number — PATHWAYS TO HOUSING VT, INC

Table of content: (NPI 1265733703)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265733703 NPI number — PATHWAYS TO HOUSING VT, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATHWAYS TO HOUSING VT, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265733703
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1233 SHELBURNE RD
Provider Second Line Business Mailing Address:
SUITE E6
Provider Business Mailing Address City Name:
SOUTH BURLINGTON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05403-7700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-492-8218
Provider Business Mailing Address Fax Number:
855-362-2766

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
191 NORTH ST
Provider Second Line Business Practice Location Address:
FLOOR ONE
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05401-4247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-492-8218
Provider Business Practice Location Address Fax Number:
855-362-2766
Provider Enumeration Date:
11/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MELTON
Authorized Official First Name:
HILARY
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
888-492-8218

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1018408 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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